Doctors around country have their letters, op-eds published in newspapers

Opportunity: Invite PNHP President Dr. Garrett Adams to speak in your area

1. More than 200 medical students, other health-professional students, physicians, nurses and health reform advocates rallied at the Vermont Statehouse in Montpelier last Saturday in a stunning show of support for a single-payer health care system.

Attired in white coats and scrubs, and accompanied by a boisterous brass band and drums, the participants – who hailed from Vermont, the Northeast and in some cases from states as far away as Oregon and New Mexico – marched from a nearby high school to the steps of the Statehouse chanting slogans like “Single Payer Now!” and “Health care is a right!” and “Everybody in! Nobody out!”

Minutes later, Sen. Bernie Sanders, I-Vt., addressed the crowd in a packed meeting room inside. “What is unique and important about your presence here today,” he said, “is that you are saying, ‘I want to be the best doctor or the best healer that I can be, but I can’t be that unless we change the system.’”

In addition to Sanders, Vermont Gov. Peter Shumlin also spoke, as did about eight health-professional students. Each of the students described a key feature of a single-payer system – truly universal, comprehensive coverage; a single, publicly financed insurance plan, administered by a public or quasi-public authority; free choice of provider; and so on – to the applause of the crowd. The program was emceed by Danielle Alexander, a second-year medical student from Albany Medical College in New York.

The March 26 rally, which was organized and led by PNHP student activists and co-sponsored by the American Medical Student Association, was the top story on the region’s evening television news. Some of the media coverage can be found here, and some of the lead-up coverage here.

Ali Thebert, PNHP’s national organizer, provided substantial support for the effort from beginning to end, with aid, of course, from PNHP members in Vermont and the Northeast. For example, PNHP med student activists such as Sim Kimmel, Kirsten Austad and Brandon Green in the Boston area filled two busloads with students; their efforts were supported by members of the Boston chapter.

Several PNHP leaders on the scene said they thought the event marked a new high-water mark in student activism for single payer. To support additional initiatives like this one, please make a tax-deductible donation to PNHP.

2. The student rally followed on the heels of an announcement by Vermont PNHP’s interim chair, Dr. Peggy Carey, a few days before that more than 200 physicians and over 50 medical students would seriously consider relocating to Vermont if it were to implement a single-payer system. About half of the physicians who said they’d consider switching to Vermont are in primary care, a category of doctors the state badly needs.

This story helped counter the arguments of single payer’s opponents in the state, who claimed that the creation of a single-payer system would cause physicians to flee Vermont. The news about the willingness of doctors to relocate was brought to the attention of the state’s lawmakers by PNHP’s Dr. Deb Richter and others, and it also received significant media coverage.

3. The situation in Vermont has grown more complex. The Shumlin administration’s bill, H.202, which was never a full-fledged single-payer bill, was severely weakened in the House before it was approved by that body on March 24. It currently stresses the implementation of the national health law, PPACA, and specifically the creation of a health insurance exchange in Vermont. The bill would keep private insurers in the system, and the very phrase “single payer” was stripped almost completely from the legislation, including from its title. It’s now called “A Road Map to a Universal and Unified Health System.” Here’s a useful analysis by Vtdigger.org, a Vermont publication.

It’s a very challenging situation, but single-payer supporters in Vermont haven’t given up and are working to strengthen the bill on the Senate side. Characteristically, the insurance industry, directly or through proxies, is stepping up its campaign to discredit the single-payer idea, using scare tactics and misinformation.

PNHP is pointing out the superiority of the single-payer solution to policy makers with projects like the student rally, the announcement about the 200 physicians willing to relocate, our members’ opinion pieces and other efforts. You can help support these measures by making a donation here.

Meanwhile, Harvard economist William Hsiao, Ph.D., had an article in the New England Journal of Medicine this month about state-based single-payer plans that you may find of interest. You can read it by clicking here.

4. Our Wisconsin members have been deeply involved in the battle to preserve their state’s health care safety net and to fend off their governor’s assault on the collective bargaining rights of public workers, including health care workers. See Dr. Chuck Benedict’s speech here, which includes links to the Wisconsin and national PNHP statements on these developments. Dr. Andy Coates has written a blog posting about similar developments in New York.

5. PNHP members have continued to advocate for single-payer national health insurance, an improved Medicare for all, in their letters to the editor and opinion pieces in newspapers from coast to coast. Since our last major round-up in late January, at least 23 op-eds or letters to the editors by our members have been published. These include one by PNHP President Garrett Adams in the Lexington Herald-Leader on medical bankruptcy and another by Dr. Margaret Flowers in Truthout on state-based single-payer efforts. (Both are appended.)

Drs. Deb Richter, Marvin Malek and Susan Deppe of Vermont have each had pieces printed in their state’s newspapers as part of the reform debate there. Drs. James Mitchiner of Michigan and Pippa Abston of Alabama have written about the dangers posed to Medicare and Medicaid by privatization and government cuts. Dr. Claudia Fegan of Illinois had articles published about the impact of PPACA on employees of large and small businesses. And Drs. Richard Weiskopf (N.Y.), Philip Caper and Julie Pease (Maine), Ralph Bovard (Minn.), James Fiesher (N.H.), Susanne King (Mass.), Jerry Frankel (Texas), Julian Gonzalez (Alaska), Bruce Trigg (N.M.), Arthur Sutherland (Tenn.), Samuel Metz (Ore.), Margaret Flowers (Md.), and med student Carl Berdahl (Conn.) all had recent op-eds or letters published in regional or national papers. (All of these and more are accessible at “Articles of Interest” on PNHP’s website.)

Please keep writing; it’s a crucial way of getting our message out. If you need help editing something you’ve written, don’t hesitate to contact Mark Almberg at mark@pnhp.org or call him (312) 782-6006.

6. Finally, we encourage you to invite PNHP President Dr. Garrett Adams of Louisville, Ky., to speak at a grand rounds or other event in your area, especially if you are located in the South. A short biography of Dr. Adams appears here. Contact Ali Thebert at ali@pnhp.org or call her at the same number given above; she’ll be happy to assist with the arrangements.

Since the passage of its landmark health reform law of 2006, the people of Massachusetts have been living like a canary in a coal mine. National health policy experts have been watching them, closely studying how they’re faring under the reform.

That watch intensified after enactment of the new federal health law, which is patterned after the Massachusetts plan. Both laws contain an individual mandate requiring people to buy private insurance, for example. The theory is that as the Bay State goes, so goes the nation.

The first reports were glowing. The number of uninsured went down. Massachusetts now boasts the lowest percentage of uninsured residents in the nation, 4.4 percent.

But with the passage of time, and despite generous dollops of supplementary federal aid to help keep the Massachusetts plan afloat, the canary isn’t looking too chipper these days.

Now comes a Harvard research study showing that despite the increase in the number of people covered, the Massachusetts reform hasn’t made a significant dent in the medical bankruptcy rate. Families still are being ruined by unpayable medical bills.

The researchers discovered that between early 2007 and mid-2009 — before and after the reform took effect — the share of medical bankruptcies in Massachusetts changed very little, from 59.3 percent to 52.9 percent. The absolute number of medical bankruptcies actually climbed from 7,504 to 10,093.

Lest you think only low-income families are being financially clobbered by medical debt, think again. Two-thirds of the bankruptcy filers were college-educated and 89 percent had health insurance when they filed their court papers.

In explanation, the authors of the study, which appears in the American Journal of Medicine, write: “Health costs in the state have risen sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance. High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs. None of that changed.”

Lead author Dr. David Himmelstein elaborates: “Massachusetts’ health reform, like the national law modeled after it, takes many of the uninsured and makes them under-insured, typically giving them a skimpy, defective private policy that’s like an umbrella that melts in the rain: The protection’s not there when you need it.”

Needless to say, these findings don’t bode well for the look-alike federal law’s ability to end the scandalous blight of medical bankruptcies in the U.S. And behind these statistics are tragic, heart-rending stories.

The crux of the problem is this: Both the Massachusetts law and the new federal law are based on the crumbling foundation of for-profit, employer-based health insurance, a financing model that has outlived its usefulness.

Our present setup is a crazy-quilt patchwork of plans that results in huge inefficiencies and mountains of wasteful paperwork — just ask your doctor! And our current arrangements contain a deeply embedded incentive for private insurers to enlarge their profits by enrolling the healthy, screening out the sick and denying claims.

In Canada, which has a truly universal, non-profit single-payer system of financing care called medicare (bearing resemblance to our own much more limited Medicare program), medical bankruptcies are virtually unknown.

Sure, you’ll hear the occasional exaggerated story about wait times in Canada. But if you want to hear real horror stories, you need look no further than our own community. And if you ask Canadians if they’d prefer a U.S.-style health system, 9 out of 10 will say no.

It’s never too late to do the right thing. Congress should move beyond patchwork solutions and implement a streamlined single-payer system, an improved Medicare for all.

The savings in bureaucracy alone would be enough to cover everyone, and the threat of medical bankruptcy would vanish overnight. Significantly a single-payer system’s bargaining power would control costs.

We can’t wait for the canary to keel over.

Dr. Garrett Adams is a pediatric infectious diseases specialist in Louisville. He is a co-founder of Physicians for a National Health Program-Kentucky and president of Physicians for a National Health Program.

State Health Law Waivers: Where Will They Take Us?

By Margaret Flowerst r u t h o u t | News Analysis, March 8, 2011

The president supports state innovation in health care, but vigilance is required to ensure state reforms improve health as we continue to call for national reform.

President Obama announced at the National Governors Association on Monday that he supports an amendment to the health law that would allow states some flexibility to innovate with their own models of health reform beginning in 2014, rather than waiting until 2017, as is currently required by law. The president’s concession comes as the current federal health law is deteriorating and states are complaining that the financial burden of complying with the law are too onerous in the face of serious budget deficits.

The president’s endorsement of the Wyden-Brown amendment, known as the “Empowering States to Innovate Act" or S.248, allows states to apply for waivers from the health insurance exchange beginning in 2014 and would give them some federal dollars to experiment with alternative ways of providing health coverage. The federal health bill requires that any state seeking a waiver from the health insurance exchange must, at a minimum, provide coverage comparable to that specified by the federal bill (Section 1332). It is left to the discretion of the secretary of health and human services to determine if a state meets this requirement.

States that put in place a single-payer health system will surpass the coverage of federal law. A single-payer health system, improved Medicare for all, would be universal and would provide the necessary cost controls and savings that would fund comprehensive coverage, including much-needed mental health, dental and vision care.

States such as Vermont and California, which appear to be closer than any others to enacting a state single-payer health system, welcomed the president’s support for the Wyden-Brown amendment because it would remove one of the many barriers they face. The amendment will still need to be passed by Congress before it arrives at the president’s desk, which may, in itself, be a formidable feat in the current political climate.

In addition, for states that want to take the path of single payer, even with the amendment, there will still be many hurdles before they can implement such a plan. The amendment only moves up the date when waivers can be applied for. It does not guarantee federal approval of the many waivers a state single-payer system would need, such as being allowed to roll their Medicaid and Medicare populations into their single-payer system.

Of concern is that the president is signaling a greater willingness to allow states to opt out of the health reform bill, not because states want to provide better coverage, but because governors in some states are opposed to the federal health law altogether. Beginning shortly after passage of the law last year, there has been an effort to undermine it through court challenges to its constitutionality and, more recently, through efforts to repeal it entirely or in part by the House. Additionally, hundreds of waivers have been issued excusing businesses, union health plans and health insurers from having to comply with parts of the law. The Department of Health and Human Services now has a 24-hour turnaround time on such waivers.

Vigilance will be required to ensure that some states do not use the amendment, if it is passed, to gut important public health programs such as Medicaid and the State Children’s Health Insurance Program and further privatize health care, which would be harmful to patients. According to a White House fact sheet released around the time of the president’s statement, “The law also allows states to submit a single application that includes Medicaid waiver requests which could, for example, seek to give people eligible for Medicaid the choice of enrolling in [health insurance] exchange plans.” A change such as this would undermine Medicaid and shift more people into more expensive and less protective private insurance plans.

Efforts are already underway in Wisconsin to take control of the state’s Medicaid programs away from the state Legislature and end the public’s ability to have a voice in the process and, instead, give full authority over the program to the governor’s office. Gov. Scott Walker appointed Dennis Smith, a former Heritage Foundation fellow who has written about moving people out of Medicaid and raising co-pays for those still in Medicaid, as his secretary of health.

Wisconsin is not alone in challenging Medicaid. According to The Wall Street Journal, more than half the states want permission to remove hundreds of thousands of people from Medicaid. Other states like New York and Arizona are cutting benefits of health programs that already provide insufficient coverage.

Decades of experience in the United States shows that the market model fails when it comes to financing health care. Health is a necessity, not a commodity. A system based on the purchase of private insurance results in higher costs and poorer outcomes. Patients who cannot afford necessary care get sick, defer treatment and develop preventable complications, sometimes fatal ones. Families experience personal bankruptcy when a serious illness or accident occurs. With increased political pressure and Secretary Sebelius already issuing hundreds of waivers, can further privatization of health care be prevented?

While some welcome the president’s support for the amendment and hope that, if it passes, a state will be able to demonstrate the benefits of a single-payer system, as happened in Saskatchewan (and which led to Canada’s national Medicare system), it is possible that the actual outcome of such an amendment will be a further attack on our necessary public health programs. For this reason, it is imperative that we continue to push for a national health program, improved Medicare for all in the US.

“It would require fewer waivers and be simpler to enact improved Medicare for all at the national level,” says Dr. Garrett Adams, president of Physicians for a National Health Program. “Not only is it simpler, but it would save lives and end personal bankruptcy caused by medical illness. We would like to see a national Medicare-for-all system enacted sooner rather than later. Every day that we wait, hundreds of Americans die of preventable causes.”

Physicians for a National Health Program advocates for a national, publicly financed and privately delivered health system: an improved Medicare for All as embodied in H.R. 676, the “Expanded and Improved Medicare for All Act.” Among the benefits of such a program are that it is a simpler system for patients and health professionals, recaptures about $400 billion annually in unnecessary paperwork and bureaucracy and directs that money into care, allows freedom to choose one’s health provider and more control over one’s treatment, is universal and provides comprehensive health benefits while at the same time effectively controlling our soaring health care costs. In this time of fiscal and health crises, national Medicare for all is more important than ever.

Margaret Flowers, M.D., is congressional fellow for Physicians for a National Health Program.